肺炎克雷伯菌对亚胺培南耐药性与其使用量的相关性研究

Correlation between imipenem consumption and imipenem resistance in Klebsiella pneumoniae

摘要:

目的探讨肺炎克雷伯菌对亚胺培南的耐药性与亚胺培南消耗量的关系。方法统计2008—2012年某院所有住院患者标本分离的肺炎克雷伯菌对亚胺培南的耐药情况，以及同期亚胺培南的消耗量（以亚胺培南使用密度表示)，分析两者相关性。结果2008—2012年临床分离的肺炎克雷伯菌分别为174、187、363、290和625株，其占总病原菌检出数的构成比分别为6.88%、7.86%、10.01%、8.07%和11.05%，差异有统计学意义（χ2=16.516，P＜0.001）。2008—2012年肺炎克雷伯菌对亚胺培南的耐药率分别为0.00%、0.00%、4.13%、10.34%和25.44%，经CochranArmitage趋势检验，差异有统计学意义（Z=12.563，P＜0.001），即肺炎克雷伯菌对亚胺培南的耐药率呈逐年增加趋势；2008—2012年亚胺培南的消耗量分别为1.24、1.60、2.14、2.78、3.71 DDDs/（1 000住院日)，呈上升趋势；亚胺培南消耗量与肺炎克雷伯菌对亚胺培南的耐药率变化呈正相关（R=0.966，P=0.007）。结论2008—2012年肺炎克雷伯菌对亚胺培南的耐药性逐年升高，与亚胺培南的消耗量密切相关，应加强对肺炎克雷伯菌的耐药性监测，并合理使用亚胺培南等碳青霉烯类抗生素。

Abstract:

ObjectiveTo evaluate the relationship between consumption of imipenem and imipenem resistance in Klebsiella pneumoniae (K. pneumoniae)．MethodsImipenem resistance in K.pneumoniae isolated from all patients in a hospital from 2008 to 2012 were analyzed, the amount of imipenem consumption during the same period was also calculated, and the correlation was analyzed.ResultsThe clinical isolates of K.pneumoniae from 2008 to 2012 were 174,187,363,290, and 625 respectively, which accounting for 6.88%，7.86%，10.01%，8.07% and 11.05% of all pathogens（χ2=16.516，P＜0.001）. Resistant rate of K. pneumoniae to imipenem from 2008—2012 was 0.00%,0.00%,4.13%,10.34%, and 25.44% respectively, CochranArmitage trend test revealed a significant difference among them(Z=12.563，P＜0.001）,namely imipenem resistance in K.pneumoniae increased year by year; annual consumption of imipenem from 2008 -2012 were 1.24, 1.60, 2.14, 2.78, and 3.71 daily defined doses/1000 patient day, there was a increased tendency in imipenem resistance; imipenem consumption had positive correlation with imipenem resistance in K. pneumoniae（R=0.966，P=0.007）.ConclusionResistance rate of K. pneumoniae to imipenem increased year by year from 2008 to 2012,which is related to the consumption of imipenem, it is important to monitor the antimicrobial resistance in K. pneumoniae and use imipenem and other carbapenems rationally.